Demographic Information Data Map

Control Label

Control Type

Table. Column

Notes

~Last

text box

MEMBER. LASTNAME

·

~First

text box

MEMBER. FIRSTNAME

·

MI

text box

MEMBER. MIDDLEINITIAL

·

~Birth Date

calendar control

MEMBER. DATEOFBIRTH

·

~Gender

drop-down list box

MEMBER. GENDER

·

~Address

text and value label

HOUSEHOLD. ADDRESS

·

~WIC Category

drop-down list box

MEMBER. WICSTATUS

·

~City

drop-down list box

HOUSEHOLD. LOCALMUNICIPALITY

LOCALMUNICIPALITY. NAME

LOCALMUNICIPALITY where = LOCALMUNICIPALITY. LOCALMUNICIPALITYID

~State

text box

HOUSEHOLD. STATE

·

~ZIP

masked edit box

HOUSEHOLD. ZIPCODE

·

Social Security Number

masked edit box

HOUSEHOLD. SSN

·

~County

drop-down list box

HOUSEHOLD. COUNTY

COUNTY. NAME

COUNTY where = COUNTY. COUNTYCD

Balto Type

text and value label

HOUSEHOLD. MOVTYPE

·

PMI #

text box

HOUSEHOLD. MEDICAIDID

·

E-mail

text box

HOUSEHOLD. EMAILADDRESS

·

Mail

group box

·

·

~Address

text box

HOUSEHOLD. MAILADDRESS

·

~City

text box

HOUSEHOLD. MAILCITY

·

~State

text box

HOUSEHOLD. MAILSTATE

·

~ZIP

masked edit box

HOUSEHOLD. MAILZIP

·

Homeless

group box

·

·

Homeless

check box

HOUSEHOLD. HOMELESS

·

Date Verified

calendar control

HOUSEHOLD. HOMELESSVERIFIEDDATE

·

~Fixed Nighttime Location

drop-down combo box

MEMBER. FIXEDLOCATIONID

Required if the Homeless check box is checked.

~ID Proof

drop-down list box

MEMBER. IDENTIFICATIONPROOF

REFERENCEDICTIONARY. DESCRIPTION

(where category = 'IDPRFCHILD' or 'IDPRFWOMAN' (depending on the WIC Category of the participant))

IDENTIFICATIONPROOF where = REFERENCEDICTIONARY. EXTERNALID

If the participant's WIC Category is Infant or Child, the ID Proof for a child is used ('IDPRFCHILD').

If the participant's WIC Category is Pregnant, Breastfeeding or Non-breastfeeding, the ID Proof for a woman is used ('IDPRFWOMAN').

~Residency Proof

drop-down list box

MEMBER. RESIDENCYPROOF

REFERENCEDICTIONARY. DESCRIPTION

(where category = 'RESIDPROOF')

RESIDENCYPROOF where = REFERENCEDICTIONARY. EXTERNALID

Telephone 1

masked edit box

HOUSEHOLD. TELEPHONE1

·

Comment

text box

HOUSEHOLD. COMMENT1

·

Telephone 2

masked edit box

HOUSEHOLD. TELEPHONE2

·

Comment

text box

HOUSEHOLD. COMMENT2

·

Physically Present

radio button group

CERTCONTACT. PHYSICALLYPRESENT

·

Reason Not Present

drop-down list box

CERTCONTACT. REASONNOTPRESENT

·

Batch Issuance

check box

MEMBER. BATCHISSUANCE

·

Maiden Name

group box

·

·

Last

text box

MEMBER. MAIDENLASTNAME

·

First

text box

MEMBER. MAIDENFIRSTNAME

·

MI

text box

MEMBER. MAIDENMIDDLEINITIAL

·

Migrant

check box

HOUSEHOLD.

·

Living with Foster Parent(s)

check box

CHILD. FOSTERPARENTS

·

Clinic Assigned

drop-down list box

MEMBER. SERVICESITEID

SERVICESITE. SERVICESITENAME

SERVICESITEID where = SERVICESITE. SERVICESITEID

~Staff Member

drop-down list box

MEMBER. USERPROFILEID

USERPROFILE. NAME

USERPROFILEID where = USERPROFILE. USERID

Control Label

Control Type

Table. Column

Notes

Local Use Questions

group box

·

·

Local Question 1

text and value label

MEMBEROTHINFO. LOCALCAPTIONID1

·

Local Question 2

text and value label

MEMBEROTHINFO. LOCALCAPTIONID2

·

Local Question 3

text and value label

MEMBEROTHINFO. LOCALCAPTIONID3

·

Local Question 4

text and value label

MEMBEROTHINFO. LOCALCAPTIONID4

·

Local Question 5

text and value label

MEMBEROTHINFO. LOCALCAPTIONID5

·

Local Question 6

text and value label

MEMBEROTHINFO. LOCALCAPTIONID6

·

Local Question 1

drop-down list box

MEMBEROTHINFO. LOCALVALUEID1

·

Local Question 2

drop-down list box

MEMBEROTHINFO. LOCALVALUEID2

·

Local Question 3

drop-down list box

MEMBEROTHINFO. LOCALVALUEID3

·

Local Question 4

drop-down list box

MEMBEROTHINFO. LOCALVALUEID4

·

Local Question 5

drop-down list box

MEMBEROTHINFO. LOCALVALUEID5

·

Local Question 6

drop-down list box

MEMBEROTHINFO. LOCALVALUEID6

·

State Use Questions

group box

·

·

State Question 1

text and value label

MEMBEROTHINFO. STATECAPTIONID1

·

State Question 2

text and value label

MEMBEROTHINFO. STATECAPTIONID2

·

State Question 3

text and value label

MEMBEROTHINFO. STATECAPTIONID3

·

State Question 4

text and value label

MEMBEROTHINFO. STATECAPTIONID4

·

State Question 5

text and value label

MEMBEROTHINFO. STATECAPTIONID5

·

State Question 6

text and value label

MEMBEROTHINFO. STATECAPTIONID6

·

State Question 1

drop-down list box

MEMBEROTHINFO. STATEVALUEID1

·

State Question 2

drop-down list box

MEMBEROTHINFO. STATEVALUEID2

·

State Question 3

drop-down list box

MEMBEROTHINFO. STATEVALUEID3

·

State Question 4

drop-down list box

MEMBEROTHINFO. STATEVALUEID4

·

State Question 5

drop-down list box

MEMBEROTHINFO. STATEVALUEID5

·

State Question 6

drop-down list box

MEMBEROTHINFO. STATEVALUEID6

·

~How Heard about WIC

drop-down list box

HOUSEHOLD. HOWHEARDABOUTWIC

·

Hardship

list box

MEMBER. HARDSHIP1

MEMBER. HARDSHIP2

MEMBER. HARDSHIP3

MEMBER. HARDSHIP4

MEMBER. HARDSHIP5

MEMBER. HARDSHIP6

·

Disability

drop-down list box

MEMBER. DISABILITY

·

Insurance Type

drop-down list box

MEMBER. INSURANCETYPE

REFERENCEDICTIONARY. DESCRIPTION

(where category = 'INSTYPE')

INSURANCETYPE where = REFERENCEDICTIONARY. EXTERNALID

Type of Medical Home

drop-down list box

MEMBER. MEDICALHOMETYPE

REFERENCEDICTIONARY. DESCRIPTION

(where category = 'MEDHOMETYPE')

MEDICALHOMETYPE where = REFERENCEDICTIONARY. EXTERNALID

Medical Home

drop-down list box

MEMBER. MEDICALHOMEID

MEDICALHOME. MEDICALHOMENAME

MEDICALHOMEID where = MEDICALHOME. MEDICALHOMEID

Medical Clinic

drop-down list box

MEMBER. MEDICALCLINICID

·

Medical Provider Name

drop-down list box

MEMBER. MEDICALPROVIDERID

·

Duplicate Participants

data grid

·

·

State WIC ID

data grid column

MEMBER. STATEWICID

·

Name

data grid column

MEMBER. FIRSTNAME + MEMBER. LASTNAME

·

User

data grid column

MEMBER. MODIFYUSERID

·

Date

data grid column

MEMBER. MODIFYDTTM

·

Control Label

Control Type

Table. Column

Notes

Household Language(s)

group box

·

·

Need Interpreter

check box

HOUSEHOLD. INTERPRETERNEEDED

·

Language1

drop-down list box

HOUSEHOLD. LANGUAGE1

·

Read

check box

HOUSEHOLD. LANGUAGE1READ

·

Spoken

check box

HOUSEHOLD. LANGUAGE1SPOKEN

·

Correspondence Preference

drop-down list box

HOUSEHOLD. LANGUAGEPREFERENCE

·

Language2

drop-down list box

HOUSEHOLD. LANGUAGE2

·

Read

check box

HOUSEHOLD. LANGUAGE2READ

·

Spoken

check box

HOUSEHOLD. LANGUAGE2SPOKEN

·

Authorized Representative

group box

·

·

Last Name

text box

HOUSEHOLD. AUTHORIZEDREPLASTNAME

·

First Name

text box

HOUSEHOLD. AUTHORIZEDREPFIRSTNAME

·

MI

text box

HOUSEHOLD. AUTHORIZEDREPMIDDLEINITIAL

·

Relationship

drop-down list box

HOUSEHOLD. AUTHREPRELATIONSHIP

·

~Marital Status

drop-down list box

HOUSEHOLD. MARITALSTATUS

REFERENCEDICTIONARY. DESCRIPTION

(where category = 'MARITALSTS')

MARITALSTATUS where = REFERENCEDICTIONARY. EXTERNALID

~Education Level

drop-down list box

HOUSEHOLD. EDUCATIONLEVEL

REFERENCEDICTIONARY. DESCRIPTION

(where category = 'EDULEVEL')

EDUCATIONLEVEL where = REFERENCEDICTIONARY. EXTERNALID

~Register to Vote

drop-down list box

HOUSEHOLD. REGISTERTOVOTE

REFERENCEDICTIONARY. DESCRIPTION

(where category = 'REGISTERTOVOTE')

REGISTERTOVOTE where = REFERENCEDICTIONARY. EXTERNALID

Alternate Representative/Proxy 1

group box

·

·

Last Name

text box

HOUSEHOLD. ALTAUTHREPLASTNAME

·

First Name

text box

HOUSEHOLD. ALTAUTHREPFIRSTNAME

·

MI

text box

HOUSEHOLD. ALTAUTHREPMIDDLEINITIAL

·

Relationship

drop-down list box

HOUSEHOLD. ALTREP1RELATIONSHIP

·

Alternate Representative/Proxy 2

group box

·

·

Last Name

text box

HOUSEHOLD. PROXYLASTNAME

·

First Name

text box

HOUSEHOLD. PROXYFIRSTNAME

·

MI

text box

HOUSEHOLD. PROXYMIDDLEINITIAL

·

Relationship

drop-down list box

HOUSEHOLD. ALTREP2RELATIONSHIP

·

Application Date

text and value label

MEMBER. APPLICATIONDATE

·

Termination Reason

text and value label

CERTCONTACT. CERTTERMREASON

REFERENCEDICTIONARY. DESCRIPTION

(where category = 'TERMREASON')

CERTTERMREASON where = REFERENCEDICTIONARY. EXTERNALID

Termination Date

text and value label

MEMBER. TERMINATEDDATE

or

CERTCONTACT. CERTTERMDATE

·

Ineligibility Reason

text and value label

CERTCONTACT. CERTINELIGIBLEREASON

·

Ineligibility Determined Date

text and value label

CERTCONTACT. CERTINELIGIBLEDATE

·

Waiting List Begin Date

text and value label

MEMBER. WAITLISTBEGINDATE

·

WIC Priority

text and value label

CERTCONTACT. CERTASSIGNEDPRIORITY

·